MSII Chapt 19 Shock.txt

Inadequate tissue perfusion resulting in impaired cellular metabolism

Deprives cells of essential oxygen and nutrients forcing cells to rely on anaerobic metabolism

Cardiovascular

Circulating blood volume, heart contractility, blood flow, vascular resistance

Inadequate blood volume to maintain the supply of oxygen and nutrients to body tissues

hemorrhage, severe diarrhea or vomiting, excessive perspiration

with burns, peritonitis, and intestinal obstruction

occurs when heart fails as a pump

cardiogenic

Physical impairment of adequate circulating blood flow

Tension pneumothorax, pericardial tamponade, PE, abdominal distension, aortic dissection

fluid collects within the pericardial sac causing compression of myocardium and resulting in reduced cardiac output and myocardial ischemia

obstruction of the superior vena cava resulting in facial or chest edema, SOB, tachycardia and hypotension

improper distribution of blood due to excessive dilation of blood vessels ot decreased vascular resistance; fluid pools in dependent areas of body and is not returned to arterial circulation

distributive

anaphylactic, septic, neurogenic

spinal cord injury above the level of the first thoracic vertebra

Disruption in the nervous system affects the vasomotor center in the medulla

bradycardia with hypotension, pooling of blood in peripheral tissues with subsequent decreased venous return and cardiac output

injury or disease of upper spinal cord, spinal anesthesia, depression of vasomotor center from certain drugs

tissue hypoxia and anoxia, respiratory failure, ARDS

metabolic acidosis

myocardial depression, widespread clotting

release of epi and norepi, mineralocorticoids and ADH; decreased LOC

depressed immune response

decreased peristalsis, impaired liver function, death of intestinal submucosa

reduced filtration, inadequate renal perfusion, tubular necrosis

activation of baroreceptors in the carotid arteries and the aorta stimulate the sym NS with increased heart rate, constriction of peripheral vessels and reduced blood flow to the kidneys, lungs, muscles and GI

decreased renal blood flow triggers release of renin and angiotensin II, adrenal cortex secretes aldosterone which promotes sodium retention by kidneys; falling blood pH and increasing arterial CO2 detected by chemoreceptors in carotid arteries stimulate respiratory center; increase R and depth help to eliminate excess CO2 and normalize blood pH

irritability, restlessness, increased P-may be thread or bounding, respirations increased rate and depth, decreased urine, cool and pale (warm and dry with septic shock), abdomen-decreased bowel sounds, increased blood glucose, thirst

systemic circulation continues to vasoconstrict to try to maintain blood flow to vital organs; decrease in peripheral blood flow leads to weak or absent pulses, blood becomes more thick, cells lack oxygen and resort to anaerobic metabolism and produce lactic acid resulting in metabolic acidosis

listless, confusion, decreased BP, narrow pulse pressure, weak and thread pulses, tachycardia, disrhytmias, R increased, deep, crackles, T subnormal (except with septic), cold, pale clammy skin, cyanosis, dry mouth

irreversible changes as compensatory mechanisms fail; tissue perfusion deteriorates, death is imminent cerebral ischemia due to decrease in cerebral blood flow

Loss OC, slow shallow R, cold clammy skin �cyanosis

blood and urine studies, measurement of hemodynamic pressure, chest radiograph, ECG, pulse OX, ABG, urine output

4 minutes

paralytics, sedatives, analgesics

normal saline intiallly;

provide water replacement and electrolytes

Albumin, remain in vascular system and draw fluid into the bloodstream

altered tissue perfusion-assessment includes all body systems

generalized inflammation that threatens vital organs

Shock, multiple transfusions, massive tissue injury, burns, pancreatitis

T<97 or >100.4, HR>90, R>20 WBC<4000 or >12000

dopamine, dobutamine, noepi, epi, nitro, vasopressin

dobutamine, norepi, vasopressin

maintains body at 33 C, may improve neurologic recovery after cardiac arrest

reduces preload with cardiogenic shock, heart pumps more efficiently, increases cardiac output

pump applies pressure during diastole and relieves during systole, reduces preload

decreases myocardial workload and O2 demand; supports circulation until heart recovers or is replaced

blood is removed from inferior VC, oxygenated, and returned via femoral artery; used for short term stabilization

cardiogenic

dilation of blood vessels

increased capillary permeability

Crystalloid fluids

MI

spinal cord injury

vasopressors

get blood to brain